Quotation Estimate Surgeon in Venezuela Caracas –Free Word Template Download with AI

Prepared By:	MediSurge International Consulting, C.A.
Address:	Av. Francisco de Miranda, Torre Empresarial, Piso 14, Chacao, Venezuela Caracas, 1060
Contact:	+58 212-555-0147 \| [email protected]
Prepared For:	Clínica San Rafael, U.R. Caracas — Attn: Dr. Alejandro Mendoza, Director of Surgical Services
Quotation Validity:	30 calendar days from the date of issue (expires July 15, 2025)
Currency:	United States Dollars (USD) — subject to applicable Venezuelan tax regulations

This Quotation Estimate is issued by MediSurge International Consulting, C.A. to provide a comprehensive financial and operational breakdown for the engagement of a qualified Surgeon to deliver specialized surgical services at Clínica San Rafael, located in the metropolitan area of Venezuela Caracas. This document outlines all professional fees, ancillary costs, logistical arrangements, and contractual conditions associated with the proposed surgical engagement. The Surgeon referenced herein is a board-certified general and laparoscopic surgeon with a minimum of fifteen (15) years of clinical experience, registered with the Colegio de Cirujanos de Venezuela and holding a valid practicing license issued by the Ministerio del Poder Popular para la Salud of the Bolivarian Republic of Venezuela.

#	Description of Service	Duration / Qty	Unit Rate (USD)	Subtotal (USD)
1	Professional fee for the Surgeon — General and Laparoscopic Surgical Procedures (per operative session, including pre-operative consultation and post-operative follow-up within 72 hours)	12 sessions	$3,500.00	$42,000.00
2	Emergency call-out fee for the Surgeon — availability on standby for urgent surgical interventions at Clínica San Rafael, Venezuela Caracas (per activation)	4 activations	$1,800.00	$7,200.00
3	Travel and accommodation for the Surgeon — international airfare, local transportation within Venezuela Caracas, and hotel lodging (5-star, Chacao or El Rosal district) for the full engagement period	45 days	$220.00/day	$9,900.00
4	Medical malpractice and professional liability insurance for the Surgeon — full coverage valid throughout the engagement period in Venezuela Caracas	1 policy	$4,500.00	$4,500.00
5	Administrative and coordination fee — visa processing, work permit facilitation, scheduling, and on-site project management by MediSurge International Consulting	1 package	$3,200.00	$3,200.00
6	Post-operative monitoring and telemedicine follow-up by the Surgeon — remote consultations for up to 30 days following each surgical procedure	12 patients	$350.00	$4,200.00
7	Continuing medical education and surgical technique workshop led by the Surgeon for the in-house surgical team at Clínica San Rafael, Venezuela Caracas (2-day intensive program)	1 event	$5,000.00	$5,000.00
TOTAL ESTIMATED COST (before applicable taxes):				$76,000.00
Applicable Venezuelan IVA (16%):				$12,160.00
GRAND TOTAL (USD):				$88,160.00

This Quotation Estimate is valid for thirty (30) calendar days from the date of issue. Any acceptance beyond this period will require a revised quotation reflecting current market rates and exchange conditions in Venezuela Caracas.
Payment terms: 40% advance payment upon execution of the service agreement; 40% upon completion of the 25th day of the engagement; 20% upon final delivery and sign-off by Clínica San Rafael.
All payments shall be made in United States Dollars (USD) via international wire transfer to the designated account of MediSurge International Consulting, C.A., in compliance with the regulations of the Banco Central de Venezuela (BCV) and the Comisión de Supervisión y Fiscalización de Seguros (SEPS).
The Surgeon shall comply with all applicable Venezuelan medical regulations, including but not limited to the Ley de Ejercicio Profesional Médico, the regulations of the Colegio de Cirujanos de Venezuela, and the bioethics protocols established by the Ministerio del Poder Popular para la Salud.
MediSurge International Consulting, C.A. shall bear full responsibility for the professional conduct, clinical competence, and ethical standards of the Surgeon throughout the engagement period in Venezuela Caracas.
Any additional surgical procedures beyond the twelve (12) sessions outlined in this Quotation Estimate shall be subject to a separate written amendment and additional fee at the rate of $3,500.00 per session.
In the event of force majeure, including but not limited to natural disasters, political instability, or public health emergencies affecting Venezuela Caracas, either party may suspend or terminate the engagement with a written notice of no fewer than five (5) business days.
This Quotation Estimate does not constitute a binding contract until both parties have executed the formal Service Agreement. All terms herein are subject to final legal review by the respective legal counsel of each party.
Confidentiality: All patient records, surgical reports, and proprietary clinical data generated during the engagement of the Surgeon in Venezuela Caracas shall remain the exclusive property of Clínica San Rafael and shall be protected under Venezuelan data protection law (Ley Orgánica de Protección de Datos Personales).

By signing below, the undersigned parties acknowledge that they have read, understood, and agree to the terms set forth in this Quotation Estimate for the engagement of a Surgeon in Venezuela Caracas. This document shall serve as the basis for the subsequent formal Service Agreement.

For MediSurge International Consulting, C.A.

Name: Dra. Carmen Villalobos
Title: Director of Medical Operations
Date: ______________________

For Clínica San Rafael, U.R. Caracas

Name: Dr. Alejandro Mendoza
Title: Director of Surgical Services
Date: ______________________ ⬇️ Download as DOCX Edit online as DOCX

Create your own Word template with our GoGPT AI prompt:

GoGPT